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Dermal equivalent

January 01, 1970

The dermal equivalent, also known as dermal replacement or neodermis, is an in vitro model of the dermal layer of skin. There is no specific way of forming a dermal equivalent, however the first dermal equivalent was constructed by seeding dermal fibroblasts into a collagen gel. This gel may then be allowed to contract as a model of wound contraction. This collagen gel contraction assay may be used to screen for treatments which promote or inhibit contraction and thus affect the development of a scar. Other cell types may be incorporated into the dermal equivalent to increase the complexity of the model. For example, keratinocytes may be seeded on the surface to create a skin equivalent, or macrophages may be incorporated to model the inflammatory phase of wound healing.[1]

A number of commercial dermal equivalents with different compositions and development methods are available. These include Integra, AlloDerm, and Dermagraft, among others.

Purpose edit

Autotransplantation has been common practice for treating individuals who have a need for skin transplants. However, there is the issue of needing repeated grafts or transplants for patients with serious injuries such as burn victims, leading to numerous problems including lack of supply of the skin, preservation, and the possibility if disease transmission.[2] Thus, this prompted for the development of various techniques to create artificial skin, including dermal equivalents.

Now, the use of dermal equivalents has expanded from burn wounds to other areas such as various reconstructive surgeries and treatment of chronic wounds.

Risks edit

There are potential risks when it comes to the application of any dermal equivalent, as there is with any skin grafting or skin substitution technique. These concerns include but are not limited to a negative immune response, possible infection, slow healing, pain, and scarring.[3]

History edit

The development of artificial skin and dermis began in the 20th century.[4] It was prompted by the discovery of the ability to isolate and culture cells in vitro, which was in 1907 by American embryologist Ross Granville Harrison when he was able to isolate and grow embryonic tissues from frogs in his laboratory.[4] In 1975, keratinocytes, which are cells that account for the majority epidermal skin cells,[5] were first isolated and successfully cultured in vitro by James G. Rheinwald and Howard Green.[6] Afterwards, in 1981, bilayer artificial skin or dermal graft was developed by John F. Burke, Ioannis V. Yannas, and other researchers, which was successful in covering “physiologically close to 60% of the body surface.”[7]

Burke’s dermal graft was one of the earliest developments of the dermal equivalent, or “neodermis”.[7] Years later, Integra artificial skin, which is now called Integra Dermal Regeneration Template (IDRT) by Integra LifeSciences, was developed from Burke et al.'s innovation.[8] It became the first commercial product approved by the FDA for dermal replacements and listed as one of the "Significant Medical Device Breakthroughs" in 1996.[9]

Commercial products and applications edit

There are a variety of dermal equivalents from how they are developed and what they are used for. The following three are some of the most commonly reviewed and assessed dermal equivalents.[10][11]

Integra edit

The initial research of dermal equivalent leading to the Integra product resulted in a bilayer structure consisting of a dermal portion and epidermal portion. The dermal portion is composed of bovine hide collagen and chondroitin 6-sulfate that is crosslinked with glutaraldehyde.[7] The epidermal portion is composed of Silastic covering the dermis.[7] For application, the bilayer structure is placed on the wound after removal of the eschar and left for several days.[7] Then, the epidermal layer is removed and replaced with artificial epidermis.[7] The dermal equivalent, or neodermis layer, is not removed as it is suitable for growth of cells and vessels.[7] The two layer process, however, may potentially lead to an infection due to any unwanted accumulation between the layers.[3] The main and primary use of Integra was for burn victims who required skin grafts.[2][7]

Integra Dermal Regeneration Template edit

Formerly known as Integra artificial skin, Integra Dermal Regeneration Template, or IDRT, was the first FDA approved product for dermal replacements. The Integra Dermal Regeneration Template’s bilayer structure is composed of bovine tendon collagen and chondroitin-6-sulfate for the dermal layer, and polysiloxane for the epidermal layer.[12] The polysiloxane epidermal layer is semipermeable, allowing for the controlled water vapor loss, flexible anti-bacterial support of the wound, and mechanical strength for the dermal equivalent.[11] The dermal layer scaffold promotes vascularization and generation of a neodermis.[11] Similar to its predecessor, the method of application is the same. IDRT has low risks of immunogenic response, as well as low disease transmission.[11]

AlloDerm edit

AlloDerm is the first type of acellular dermal matrix (ADM) derived from the skin of cadavers from the collagen fiber network after the removal of the epidermal layer of the cadaveric skin.[13][14] It is widely used in dental surgeries for gingival grafting,[15] abdominal hernia repair,[13] oculoplastic and orbital surgeries,[14] and breast surgeries.[16] Due to its acellular structure, there is no immunogenic response caused from the application of AlloDerm.[11]

Dermagraft edit

Dermagraft is a human fibroblast–derived dermal replacement.[17] It is derived from neonatal dermal fibroblasts implanted into a bioabsorbable polyglactin mesh scaffold along with extracellular matrix proteins that are secreted by the fibroblasts.[17] It can promote re-epithelization, however, there is a potential for antigenic response.[11] Dermagraft is mainly used for the treatment of chronic wounds such as various ulcers including diabetic foot ulcers and venous foot ulcers.[17] It received premarket approval from the FDA in 2001 for the treatment of diabetic foot ulcers.[18][19]

See also edit

References edit

  1. ^ Newton PM, Watson JA, Wolowacz RG, Wood EJ (August 2004). "Macrophages restrain contraction of an in vitro wound healing model". Inflammation. 28 (4): 207–214. doi:10.1023/B:IFLA.0000049045.41784.59. PMID 15673162. S2CID 9612298.
  2. ^ a b Greenfield E, Jordan B (June 1996). "Advances in burn wound care". Critical Care Nursing Clinics of North America. Wound Care. 8 (2): 203–215. doi:10.1016/S0899-5885(18)30336-8. PMID 8716388.
  3. ^ a b Alrubaiy L, Al-Rubaiy KK (January 2009). "Skin substitutes: a brief review of types and clinical applications". Oman Medical Journal. 24 (1): 4–6. doi:10.5001/omj.2009.2. PMC 3269619. PMID 22303500.
  4. ^ a b Pickerill HP (October 1951). "On the possibility of establishing skin banks". British Journal of Plastic Surgery. 4 (3): 157–165. doi:10.1016/s0007-1226(51)80028-6. PMID 14886567.
  5. ^ McGrath JA (2004). "Anatomy and Organization of Human Skin". Rook's Textbook of Dermatology. John Wiley & Sons, Ltd. pp. 45–128. doi:10.1002/9780470750520.ch3. ISBN 978-0-470-75052-0.
  6. ^ Rheinwald JG, Green H (November 1975). "Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells". Cell. 6 (3): 331–343. doi:10.1016/s0092-8674(75)80001-8. PMID 1052771. S2CID 53294766.
  7. ^ a b c d e f g h Burke JF, Yannas IV, Quinby WC, Bondoc CC, Jung WK (October 1981). "Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury". Annals of Surgery. 194 (4): 413–428. doi:10.1097/00000658-198110000-00005. PMC 1345315. PMID 6792993.
  8. ^ "Artificial Skin: The Innovation That Changed Complex Burn Wound Care Forever". ITT Blog | Integra LifeSciences. 2021-04-23. Retrieved 2021-10-27.
  9. ^ Office of Device Evaluation (2009-01-20). (PDF). Food and Drug Administration. Archived from the original (PDF) on 2009-01-20. Retrieved 2021-10-27.
  10. ^ Kirsner RS, Falanga V, Eaglstein WH (June 1998). "The development of bioengineered skin". Trends in Biotechnology. 16 (6): 246–249. doi:10.1016/S0167-7799(98)01196-2. PMID 9652135.
  11. ^ a b c d e f Savoji H, Godau B, Hassani MS, Akbari M (2018). "Skin Tissue Substitutes and Biomaterial Risk Assessment and Testing". Frontiers in Bioengineering and Biotechnology. 6: 86. doi:10.3389/fbioe.2018.00086. PMC 6070628. PMID 30094235.
  12. ^ "Integra® Dermal Regeneration Template" (PDF). (PDF) from the original on 2021-03-25.
  13. ^ a b Buinewicz B, Rosen B (February 2004). "Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair". Annals of Plastic Surgery. 52 (2): 188–194. doi:10.1097/01.sap.0000100895.41198.27. PMID 14745271. S2CID 46170403.
  14. ^ a b Park SJ, Kim Y, Jang SY (January 2018). "The application of an acellular dermal allograft (AlloDerm) for patients with insufficient conjunctiva during evisceration and implantation surgery". Eye. 32 (1): 136–141. doi:10.1038/eye.2017.161. PMC 5770710. PMID 28799557.
  15. ^ Shaikh MS, Lone MA, Matabdin H, Lone MA, Soomro AH, Zafar MS (February 2021). "Regenerative Potential of Enamel Matrix Protein Derivative and Acellular Dermal Matrix for Gingival Recession: A Systematic Review and Meta-Analysis". Proteomes. 9 (1): 11. doi:10.3390/proteomes9010011. PMC 8005981. PMID 33668721.
  16. ^ Macadam SA, Lennox PA (2012-05-01). "Acellular dermal matrices: Use in reconstructive and aesthetic breast surgery". The Canadian Journal of Plastic Surgery. 20 (2): 75–89. doi:10.1177/229255031202000201. PMC 3383551. PMID 23730154.
  17. ^ a b c Hart CE, Loewen-Rodriguez A, Lessem J (June 2012). "Dermagraft: Use in the Treatment of Chronic Wounds". Advances in Wound Care. 1 (3): 138–141. doi:10.1089/wound.2011.0282. PMC 3623576. PMID 24527294.
  18. ^ Zhang Z, Michniak-Kohn BB (January 2012). "Tissue engineered human skin equivalents". Pharmaceutics. 4 (1): 26–41. doi:10.3390/pharmaceutics4010026. PMC 3834903. PMID 24300178.
  19. ^ "Summary of Safety and Effectiveness Data" (PDF). Food and Drug Administration. September 2001. (PDF) from the original on 2017-01-27.


External links edit

January 01, 1970
dermal, equivalent, dermal, equivalent, also, known, dermal, replacement, neodermis, vitro, model, dermal, layer, skin, there, specific, forming, dermal, equivalent, however, first, dermal, equivalent, constructed, seeding, dermal, fibroblasts, into, collagen,. The dermal equivalent also known as dermal replacement or neodermis is an in vitro model of the dermal layer of skin There is no specific way of forming a dermal equivalent however the first dermal equivalent was constructed by seeding dermal fibroblasts into a collagen gel This gel may then be allowed to contract as a model of wound contraction This collagen gel contraction assay may be used to screen for treatments which promote or inhibit contraction and thus affect the development of a scar Other cell types may be incorporated into the dermal equivalent to increase the complexity of the model For example keratinocytes may be seeded on the surface to create a skin equivalent or macrophages may be incorporated to model the inflammatory phase of wound healing 1 A number of commercial dermal equivalents with different compositions and development methods are available These include Integra AlloDerm and Dermagraft among others Contents 1 Purpose 1 1 Risks 2 History 3 Commercial products and applications 3 1 Integra 3 1 1 Integra Dermal Regeneration Template 3 2 AlloDerm 3 3 Dermagraft 4 See also 5 References 6 External linksPurpose editAutotransplantation has been common practice for treating individuals who have a need for skin transplants However there is the issue of needing repeated grafts or transplants for patients with serious injuries such as burn victims leading to numerous problems including lack of supply of the skin preservation and the possibility if disease transmission 2 Thus this prompted for the development of various techniques to create artificial skin including dermal equivalents Now the use of dermal equivalents has expanded from burn wounds to other areas such as various reconstructive surgeries and treatment of chronic wounds Risks edit There are potential risks when it comes to the application of any dermal equivalent as there is with any skin grafting or skin substitution technique These concerns include but are not limited to a negative immune response possible infection slow healing pain and scarring 3 History editThe development of artificial skin and dermis began in the 20th century 4 It was prompted by the discovery of the ability to isolate and culture cells in vitro which was in 1907 by American embryologist Ross Granville Harrison when he was able to isolate and grow embryonic tissues from frogs in his laboratory 4 In 1975 keratinocytes which are cells that account for the majority epidermal skin cells 5 were first isolated and successfully cultured in vitro by James G Rheinwald and Howard Green 6 Afterwards in 1981 bilayer artificial skin or dermal graft was developed by John F Burke Ioannis V Yannas and other researchers which was successful in covering physiologically close to 60 of the body surface 7 Burke s dermal graft was one of the earliest developments of the dermal equivalent or neodermis 7 Years later Integra artificial skin which is now called Integra Dermal Regeneration Template IDRT by Integra LifeSciences was developed from Burke et al s innovation 8 It became the first commercial product approved by the FDA for dermal replacements and listed as one of the Significant Medical Device Breakthroughs in 1996 9 Commercial products and applications editThere are a variety of dermal equivalents from how they are developed and what they are used for The following three are some of the most commonly reviewed and assessed dermal equivalents 10 11 Integra edit The initial research of dermal equivalent leading to the Integra product resulted in a bilayer structure consisting of a dermal portion and epidermal portion The dermal portion is composed of bovine hide collagen and chondroitin 6 sulfate that is crosslinked with glutaraldehyde 7 The epidermal portion is composed of Silastic covering the dermis 7 For application the bilayer structure is placed on the wound after removal of the eschar and left for several days 7 Then the epidermal layer is removed and replaced with artificial epidermis 7 The dermal equivalent or neodermis layer is not removed as it is suitable for growth of cells and vessels 7 The two layer process however may potentially lead to an infection due to any unwanted accumulation between the layers 3 The main and primary use of Integra was for burn victims who required skin grafts 2 7 Integra Dermal Regeneration Template edit Formerly known as Integra artificial skin Integra Dermal Regeneration Template or IDRT was the first FDA approved product for dermal replacements The Integra Dermal Regeneration Template s bilayer structure is composed of bovine tendon collagen and chondroitin 6 sulfate for the dermal layer and polysiloxane for the epidermal layer 12 The polysiloxane epidermal layer is semipermeable allowing for the controlled water vapor loss flexible anti bacterial support of the wound and mechanical strength for the dermal equivalent 11 The dermal layer scaffold promotes vascularization and generation of a neodermis 11 Similar to its predecessor the method of application is the same IDRT has low risks of immunogenic response as well as low disease transmission 11 AlloDerm edit AlloDerm is the first type of acellular dermal matrix ADM derived from the skin of cadavers from the collagen fiber network after the removal of the epidermal layer of the cadaveric skin 13 14 It is widely used in dental surgeries for gingival grafting 15 abdominal hernia repair 13 oculoplastic and orbital surgeries 14 and breast surgeries 16 Due to its acellular structure there is no immunogenic response caused from the application of AlloDerm 11 Dermagraft edit Dermagraft is a human fibroblast derived dermal replacement 17 It is derived from neonatal dermal fibroblasts implanted into a bioabsorbable polyglactin mesh scaffold along with extracellular matrix proteins that are secreted by the fibroblasts 17 It can promote re epithelization however there is a potential for antigenic response 11 Dermagraft is mainly used for the treatment of chronic wounds such as various ulcers including diabetic foot ulcers and venous foot ulcers 17 It received premarket approval from the FDA in 2001 for the treatment of diabetic foot ulcers 18 19 See also editTissue engineering Artificial skin Regenerative medicine Regeneration in humansReferences edit Newton PM Watson JA Wolowacz RG Wood EJ August 2004 Macrophages restrain contraction of an in vitro wound healing model Inflammation 28 4 207 214 doi 10 1023 B IFLA 0000049045 41784 59 PMID 15673162 S2CID 9612298 a b Greenfield E Jordan B June 1996 Advances in burn wound care Critical Care Nursing Clinics of North America Wound Care 8 2 203 215 doi 10 1016 S0899 5885 18 30336 8 PMID 8716388 a b Alrubaiy L Al Rubaiy KK January 2009 Skin substitutes a brief review of types and clinical applications Oman Medical Journal 24 1 4 6 doi 10 5001 omj 2009 2 PMC 3269619 PMID 22303500 a b Pickerill HP October 1951 On the possibility of establishing skin banks British Journal of Plastic Surgery 4 3 157 165 doi 10 1016 s0007 1226 51 80028 6 PMID 14886567 McGrath JA 2004 Anatomy and Organization of Human Skin Rook s Textbook of Dermatology John Wiley amp Sons Ltd pp 45 128 doi 10 1002 9780470750520 ch3 ISBN 978 0 470 75052 0 Rheinwald JG Green H November 1975 Serial cultivation of strains of human epidermal keratinocytes the formation of keratinizing colonies from single cells Cell 6 3 331 343 doi 10 1016 s0092 8674 75 80001 8 PMID 1052771 S2CID 53294766 a b c d e f g h Burke JF Yannas IV Quinby WC Bondoc CC Jung WK October 1981 Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury Annals of Surgery 194 4 413 428 doi 10 1097 00000658 198110000 00005 PMC 1345315 PMID 6792993 Artificial Skin The Innovation That Changed Complex Burn Wound Care Forever ITT Blog Integra LifeSciences 2021 04 23 Retrieved 2021 10 27 Office of Device Evaluation 2009 01 20 Annual Report Fiscal Year 1996 October 1 1995 September 30 1996 PDF Food and Drug Administration Archived from the original PDF on 2009 01 20 Retrieved 2021 10 27 Kirsner RS Falanga V Eaglstein WH June 1998 The development of bioengineered skin Trends in Biotechnology 16 6 246 249 doi 10 1016 S0167 7799 98 01196 2 PMID 9652135 a b c d e f Savoji H Godau B Hassani MS Akbari M 2018 Skin Tissue Substitutes and Biomaterial Risk Assessment and Testing Frontiers in Bioengineering and Biotechnology 6 86 doi 10 3389 fbioe 2018 00086 PMC 6070628 PMID 30094235 Integra Dermal Regeneration Template PDF Archived PDF from the original on 2021 03 25 a b Buinewicz B Rosen B February 2004 Acellular cadaveric dermis AlloDerm a new alternative for abdominal hernia repair Annals of Plastic Surgery 52 2 188 194 doi 10 1097 01 sap 0000100895 41198 27 PMID 14745271 S2CID 46170403 a b Park SJ Kim Y Jang SY January 2018 The application of an acellular dermal allograft AlloDerm for patients with insufficient conjunctiva during evisceration and implantation surgery Eye 32 1 136 141 doi 10 1038 eye 2017 161 PMC 5770710 PMID 28799557 Shaikh MS Lone MA Matabdin H Lone MA Soomro AH Zafar MS February 2021 Regenerative Potential of Enamel Matrix Protein Derivative and Acellular Dermal Matrix for Gingival Recession A Systematic Review and Meta Analysis Proteomes 9 1 11 doi 10 3390 proteomes9010011 PMC 8005981 PMID 33668721 Macadam SA Lennox PA 2012 05 01 Acellular dermal matrices Use in reconstructive and aesthetic breast surgery The Canadian Journal of Plastic Surgery 20 2 75 89 doi 10 1177 229255031202000201 PMC 3383551 PMID 23730154 a b c Hart CE Loewen Rodriguez A Lessem J June 2012 Dermagraft Use in the Treatment of Chronic Wounds Advances in Wound Care 1 3 138 141 doi 10 1089 wound 2011 0282 PMC 3623576 PMID 24527294 Zhang Z Michniak Kohn BB January 2012 Tissue engineered human skin equivalents Pharmaceutics 4 1 26 41 doi 10 3390 pharmaceutics4010026 PMC 3834903 PMID 24300178 Summary of Safety and Effectiveness Data PDF Food and Drug Administration September 2001 Archived PDF from the original on 2017 01 27 External links editIntegra AlloDerm Dermagraft Archived 2021 10 07 at the Wayback Machine Retrieved from https en wikipedia org w index php title Dermal equivalent amp oldid 1199902379, wikipedia, wiki, book, books, library,

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